Tag Archives: Injured Workers

Deaf, Dumb and Blind, part Deux

Back in June, I wrote a post with the above mentioned title. Then, I was on a rant, now I am just reporting what my fellow blogger, Joe Paduda has written about today regarding a report from the U.S. Department of Labor (DOL) on the various state workers’ compensation systems.

This report harks back to one conducted in 1972 on the state of workers’ compensation then, but as Joe points out today, seeking a return to that Commission report and to that decades-old recommendations is absurd.

Rather than give you my take on this meeting from yesterday, here is Joe’s article. I always give credit where it is due, and he is due a lot of credit for his reporting.

It would seem that not only is the workers’ comp industry deaf, dumb and blind, but so is the federal government, if we are to take Joe at his word.

And in the meantime, who gets hurt while these eggheads, bureaucrats, nincompoops and sticks-in-the-muds do more study, research, look back forty years and pine for an economy and workforce that no longer exists? The injured workers.

And who, in the meantime, while the insurers, employers, and various stakeholders gouge and game the system, gets hurt, disabled or even dies? The injured workers.

It seems to me that the only thing that matters to the eggheads, bureaucrats, nincompoops, sticks-in-the-muds, insurers, employers, and various stakeholders is, how to screw the worker, save money by not paying adequate wages and benefits, make more profits off of someone’s disability, and not the care and treatment of the one who is disabled and forced into poverty.

Here is the perfect example of the state of affairs in workers’ comp, both inside and outside the industry:

hear-no-evil-see-no-evil-speak-no-evil

 

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GoFundMe??? Really!!!

Here is a case of an injured worker who was denied work comp when he fell down some stairs at work, and now had to have his wife start a GoFundMe account.

A former co-worker of mine when I worked for a large insurance broker also fell going down stairs in the building we worked in, and he did not have this problem.

THIS IS UNCONSCIONABLE. THIS IS EXACTLY WHAT COMP IS FOR. FAMILIES SHOULD NOT HAVE TO GO BROKE IF SOMEONE SLIPS AND FALLS DOWN A FLIGHT OF STAIRS ON THE WORK PREMISES.

This is the result of too many cooks and too many lawyers mucking up the system, which forces the carriers or the employers to deny or seek the denial of benefits.

If any of you feel charitable, here is the link to the GoFundMe page:

https://www.gofundme.com/2n5y8apc

Now you know why I call my blog “Transforming Workers’ Comp”. This has to stop.

Florida Workers’ Comp Outcomes Similar to 14 Other States

Introduction

Earlier this week, the Workers’ Compensation Research Institute (WCRI), released a study that compared the outcomes for injured workers across 15 states. It can be purchased here.

Each state has a separate, multi-page report, so I requested a copy of the report for Florida, as that is where I currently reside (offers of employment elsewhere are greatly appreciated).

As this report has over 100 pages, it is reasonable to assume that 15 such reports would have a combined 1500 pages or more. So, I took the easy way and just looked at one state.

In the introduction to the report, there are two key dimensions of the performance of any workers’ comp system in the US:

  1. Post-injury outcomes achieved by injured workers and;
  2. Costs paid by employers.

The study measured the following worker outcomes:

  • Recovery of physical health and functioning
  • Return to work
  • Earnings recovery
  • Access to medical care
  • Satisfaction with medical care

The study was also conducted in three phases:

  • Phase 1: Eight states (IN, MA, MI, MN, NC, PA, VA, WI)
  • Phase 2: Four states: (IA, AR, CT, TN)
  • Phase 3: Three states: (FL, GA, KY)

The WCRI will collect data from other states and revisit states from earlier phases that implemented reforms to measure the impact of those reforms on outcomes in subsequent phases.

Key Findings for Florida

The WCRI found that workers in Florida reported outcomes that were similar to the median study on some of the key measures, but they reported somewhat higher rates of problems accessing desired services, accessing desired providers, and higher dissatisfaction with overall medical care.

For Recovery of physical health and functioning, they found that for Florida, it was similar to the other 14 states.

For Return to work, injured workers in Florida reported rates of return to work in the middle range of the study. 14% of Florida workers with more than seven days of lost time reported never having a return to work that lasted at least one month due to the injury as of three years’ post-injury; 17% reported no return to work within one year of injury. The median worker in Florida had a return to work about 12 weeks after injury.

For Earnings Recovery, 11% of Florida injured workers reported earning “a lot less” at the time of return to work; the median was 8%.

For Access to care, 21% of Florida injured workers reported they had “big problems” getting the services they or their provider wanted; 20% reported “big problems” getting the primary provider they wanted. Florida was among the states, the study reported, with higher rates of problems of access to care and providers, and higher or somewhat higher than in nine or eight other states.

For Satisfaction with care, the study found nearly three in four Florida workers were “somewhat” or “very” satisfied with their overall care (71%); however, 20% said they were “very dissatisfied”. This was higher than the median of the states, and higher than in 10 states.

Table 1 is a comparison of the medical costs and outcomes between Florida and the other 14 states in the WCRI study. What is interesting to note is that when compared to the other 14 states, Florida had similar outcomes in many of the measures, as the study suggested.

Table 1

Source: WCRI

The study found that medical costs in Florida, recovery of health and functioning, rates of return to work, duration of time before return to work were typical, while problems with getting desired services, and providers were somewhat higher or higher. Satisfaction was lower, but dissatisfaction was higher.

What I found interesting, and perhaps a little disturbing, but not unexpected, was that with the exception of the percentage of satisfaction, all the figures were below 50%, and while the score mechanism for recovery of health and functioning is not further discussed in the Summary, but is mentioned in the notes, those also seem to be very low.

I am not surprised that Florida has a higher percentage of dissatisfaction with medical care, this despite the fact that everywhere you look in Florida cities and towns, there are hundreds of medical offices, clinics, and many hospitals; some large, some small.

What to make of this?

While it is too early to tell how these 15 states compare with the other 35 states, what we can gather from this data is that the workers’ comp systems in these states are falling far short of where they should be in almost all of the measures.

Satisfaction percentages, notwithstanding, there are real issues with the way injured workers are treated in these 15 states.

That Florida is similar to 14 other states in five outcome measures, and not even above 50%, tells me that the industry needs to stop kidding itself that everything is honky-dory. It’s not.

How worse do you think it would be if the only current alternative being suggested is the opt-out option? If workers are not getting back to work or getting better care or better health and functioning under the current state systems, how do you think it would be if states like FL, GA, KY, NC, TN and VA go to opt-out as ARAWC is trying to do?

And without going into the details of each states report, it is hard to know just how much of these outcomes are related to common workers’ comp surgeries that could be provided for by outside medical facilities in other nations in the Western hemisphere?

Denying injured workers, the access to the services and providers they want or need is not a sign that everything is okay, having long-delayed return to work three years after injury is not okay, and earning less after an injury is also not okay.

WHEN ARE YOU GOING TO WAKE UP OUT OF YOUR DREAMSTATES AND REALIZE THERE ARE MAJOR PROBLEMS HERE THAT ARE NOT BEING SOLVED?

WHEN ARE YOU GOING TO STOP LISTENING TO PEOPLE WHO DO NOT WANT TO IMPROVE THE SYSTEM BECAUSE IT ONLY SERVES TO MAKE THEM WEALTHIER OR SOMEONE ELSE WEALTHIER?

WHEN ARE YOU GOING TO REALIZE THAT AMERICAN PHYSICIANS ARE NOT THE ONLY ONES WHO CAN PRACTICE MEDICINE, AND MAY EVEN BE BETTER THAN THOSE HERE WHO ARE ONLY IN IT FOR THE MONEY?

No matter how many studies or reports the WCRI or NCCI, or anyone else issues, until you disavow yourselves of the notion that workers’ compensation is failing and that there are ways to fix it, it will just get worse, until one day it is no longer here for anyone.


I am willing to work with any broker, carrier, or employer interested in saving money on expensive surgeries, and to provide the best care for their injured workers or their client’s employees.

Ask me any questions you may have on how to save money on expensive surgeries under workers’ comp.

I am also looking for a partner who shares my vision of global health care for injured workers.

I am also willing to work with any health care provider, medical tourism facilitator or facility to help you take advantage of a market segment treating workers injured on the job. Workers’ compensation is going through dramatic changes, and may one day be folded into general health care. Injured workers needing surgery for compensable injuries will need to seek alternatives that provide quality medical care at lower cost to their employers. Caribbean and Latin America region preferred.

Call me for more information, next steps, or connection strategies at (561) 738-0458 or (561) 603-1685, cell. Email me at: richard_krasner@hotmail.com.

Will accept invitations to speak or attend conferences.

Connect with me on LinkedIn, check out my website, FutureComp Consulting, and follow my blog at: richardkrasner.wordpress.com.

Transforming Workers’ Comp Blog is now viewed all over the world in over 250 countries and political entities. I have published nearly 300 articles, many of them re-published in newsletters and other blogs.

Share this article, or leave a comment below.

“Florida, We Have a Problem”

Tuesday, Judge David Langham, Deputy Chief Judge of Compensation Claims for the Florida Office of Judges of Compensation Claims and Division of Administrative Hearings, wrote a rather lengthy post about the differences between cost-shifting and case-shifting in workers’ comp.

Much of what the Judge wrote were subjects that I already discussed in a number of previous posts about cost-shifting and case-shifting, so I won’t go into it here. I am only focusing on the parts that relate to Florida workers’ comp. You can read the entire article yourselves.

But what caught my attention was what he said about Florida and what the Workers’ Compensation Research Institute (WCRI) reported in some of their studies on these issues.

As Judge Langham wrote this week, he wrote a post two years ago that asked the question “Why Does Surgery Cost Double in Workers’ Compensation?”

Judge Langham noted in that post that Florida employers have been documented paying almost double for shoulder or knee surgery that is paid for under workers’ compensation, compared to group health costs.

The implication of case-shifting in Florida, he says, could arguably be a doubling of cost.

He cited a WCRI report released earlier this year that suggests however that case-shifting is perhaps not as likely in Florida.

According to the report, Judge Langham continues, “as of July 2011, six states had workers’ comp medical fee schedules with rates within 15% of Medicare rates. They were California, Massachusetts, Florida, North Carolina, New York and Hawaii.”

However, Judge Langham pointed out that the WCRI concluded that case-shifting is more likely in states where the workers’ compensation fee schedule is 20% or more above the group health rates, and not in Florida.

Judge Langham stated that this analysis of workers’ compensation fee schedules does not appear to include analysis of the reimbursement rates for hospitals, and that It also seems contradictory to the assertions that Florida workers’ compensation costs for various surgeries have been documented as roughly double the group health rates (100% higher, not 15% higher).

Injured workers who missed work in the Florida workers’ compensation system could be compensated in 2016 at a rate as high as $862.51 per week, the “maximum compensation rate.”

So, if recovery from such a “soft-tissue” injury required ten weeks off-work, he wrote, the case-shifting to workers’ compensation might add another four to nine thousand dollars to the already doubled cost of surgical repair under workers’ compensation.

This could be directly borne by the employer if the employer is self-insured for workers’ compensation; or, if the employer has purchased workers’ compensation insurance, the effect on the employer would be indirect in the form of potentially increased premium costs for workers’ compensation following such events and payments, Judge Langham states.

According to WCRI, the Judge quotes, “policymakers have always focused on the impact (workers’ compensation) fee schedules have on access to care as well as utilization of services.

This has been a two-part analysis, he says:

First, fee schedules have to be sufficient such that physicians are willing to provide care in the workers’ compensation system; and second, the reimbursement cannot be too high, or perhaps overutilization is encouraged.

Lastly, Judge Langham points out that the disparity between costs has also been noted in discussions of “medical tourism.”

The last question he posits is this, “might medical decision makers direct care to more efficient providers, across town, across state lines?”

What about national borders?


I am willing to work with any broker, carrier, or employer interested in saving money on expensive surgeries, and to provide the best care for their injured workers or their client’s employees.

Ask me any questions you may have on how to save money on expensive surgeries under workers’ comp.

I am also looking for a partner who shares my vision of global health care for injured workers.

I am also willing to work with any health care provider, medical tourism facilitator or facility to help you take advantage of a market segment treating workers injured on the job. Workers’ compensation is going through dramatic changes, and may one day be folded into general health care. Injured workers needing surgery for compensable injuries will need to seek alternatives that provide quality medical care at lower cost to their employers. Caribbean and Latin America region preferred.

Call me for more information, next steps, or connection strategies at (561) 738-0458 or (561) 603-1685, cell. Email me at: richard_krasner@hotmail.com.

Will accept invitations to speak or attend conferences.

Connect with me on LinkedIn, check out my website, FutureComp Consulting, and follow my blog at: richardkrasner.wordpress.com.

Transforming Workers’ Blog is now viewed all over the world in 250 countries and political entities. I have published nearly 300 articles, many of them re-published in newsletters and other blogs.

Share this article, or leave a comment below.

New York Docs Refuse to Accept Injured Workers

In a video report on New York TV station WNBC-TV, an injured worker was referred to a list of ophthalmologists in Brooklyn by the New York Workers’ Compensation Board (WCB), and all doctors on the list refused to accept workers’ compensation, even though the state’s online database said they did.

The reporter, Chris Glorioso, contacted every doctor on the list and was told the same thing that the injured worker, George Akturk, was told, and even one doctor told Glorioso that they used to accept workers’ comp twenty years ago.

According to the report, the results showed that the state’s list of authorized practitioners was severely outdated.

Although each doctor was listed as a workers’ comp participant, Glorioso discovered,  two-thirds of the offices reported they do not participate in the program.

He also found that thirteen doctors’ offices reported they do accept workers’ comp, but most of them do not perform the kind of retinal surgery prescribed for Akturk.

 Dr Michael Lax, director of the SUNY Upstate Occupational Health Clinic, said the real reason doctors are dropping out of the system is that insurance companies and state regulators increasingly control medical decisions.

In 2010, New York adopted medical treatment guidelines that restrict the medical discretion of specialists.

This is another example of how so-called workers’ comp ‘reforms’ are directed not towards improving the lives of the injured workers, but to save money for the carriers, and that regulators are more interested in restricting medical care than treating the injured worker and getting them back to work faster.

Here is the link to the report and accompanying video:

http://www.nbcnewyork.com/investigations/NY-Refers-Injured-Workers-to-Docs-that-Dont-Accept-Workers-Comp-372153352.html

Employer Choice States See Lower Claim Costs

Introduction

When I started this blog three years ago, one of the first topics I covered was the issue of employee/employer choice of treating physician (see “Employee vs Employer Choice of Physician: How best to Incorporate Medical Tourism into Workers’ Compensation” and “Employee vs. Employer Choice of Physician Revisited: Additional Commentary on How Best to Incorporate Medical Tourism into Workers’ Compensation“).

Then in March of this year, ProPublica’s Michael Grabell and NPR’s Howard Berkes, wrote an article called, “The Demolition of Workers’ Compensation“, which was a first in of a series about the workers’ compensation system.

In the article, Grabell said that in 37 states, the worker cannot choose his doctor, or they are restricted to a list provided by their employer. This statement generated some concern from the industry.

My fellow blogger, Joe Paduda tried to get them to see both sides, but gave up the effort when it did not result in any discussion between them, as he wrote about the following day, calling the reporting a “public disservice”.

The next day, I wrote to Mr. Grabell, and told him that his facts were wrong. He told me in his response that he relied on data from the US Chamber of Commerce.

I told him that the WCRI and the state statutes were a more accurate source of information. My email thread covered eight messages that day. I provided him with the data I used in the articles cited above, and in the presentation I gave the previous November in Mexico.

Lower Costs When Doctor is Chosen By Employer

Business Insurance’s Stephanie Goldberg today reported on a study published in the latest issue of the Journal of Occupational and Environmental Medicine, that found that the average medical cost per work comp claim is lower in states where the employer chooses the worker’s initial treating physician.

Average medical costs were $308 lower in those states where the employer can choose the treating doctor for employees with low back pain, than in states where the workers were allowed to choose, Goldberg reported.

The study, sponsored by the Liberty Mutual Research Institute for Safety, said that states limiting treating provider change had higher medical costs than states that allow a one-time change.

There was however, the study found, no significant difference in average medical costs between cases in states that limit initial change and states that don’t, according to Goldberg.

Employers participating in a managed care organization, preferred provider organization or coordinated care organization in states like California and Florida, are allowed to to direct care. States like Arizona and Massachusetts allow workers to chose their providers.

The study also found, that the average medical costs ranges from $1211 in New York to $4514 in Texas, and length of disability ranged from 19 days in Missouri to 69 days in Texas.

The study was compiled using more that 59,000 low back pain claims between 2002 and 2009 from 49 jurisdictions, including Washington, DC, and did not include North Dakota and Wyoming.

Challenges Facing Work Comp

In three weeks, members of the medical tourism industry will gather in Puerto Vallarta, Mexico to attend the 6th Mexico Medical Tourism Congress.

You may recall that I was invited and attended the Congress last year, and was invited again this year. However, due to personal and financial reasons, I am not attending this year.

I am however, posting my PowerPoint presentation below for your viewing, with narration by yours truly. I hope you find it interesting and informative.

Challenges Facing Workers’ Comp (PowerPoint)

Challenges Facing Workers’ Comp (video)